Editorial

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Welcome to the May 2012 homepage edition of i2P-Information to Pharmacists. Rollo Manning has been having some time out having staples removed from the site of his open heart surgery.He is now at home recuperating in Darwin, having arrived home last Friday, beating a cold and hasty retreat from Canberra.We all wish him a speedy recovery and hopefully, he will be fit enough to contribute by next month.
This month, Pharmedia discusses the toll that is taken when someone complains about you to an authority without good cause. Well, the good news is that you can now take action to protect yourself if such a complaint is made, and that may even include action for defamation. Read about a recent case involving two doctors, with Mark Coleman drawing on personal experience to illustrate.

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Remember Grandma’s words

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Pat Gallagher articles by this author...

Patrick Gallagher is well known in Information Technology circles. He has a vital interest in e-health, particularly in the area of shared records and e-prescriptions, also supply chain issues. He maintains a very clear vision of what ought to be, but he and many others in the IT field, are frustrated by government agencies full of experts who have never actually worked in a professional health setting. So we see ongoing wastage, astronomical spends and "top down" systems that are never going to work. Patrick needs to be listened to.

Fair dinkum, we can be forgiven for not knowing whether to laugh or cry.

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We seem to be living in one huge shadowy culture. Facts and stories abound about bad stuff happening but where the news is obfuscated because either it is a secret or we are simply not told the truth

The taxpayer is investing billions in healthcare in its many and often complex forms.
Meanwhile the public servant class, both elected and departmental, spend our money with great self-importance but frequently take little responsibility for doing so.
Most of us would agree – anecdotally – that this all too familiar behaviour revolves around preserving and exercising administration overkill, while suffering a lack of personal autonomy and fulfillment, which cycles through and creates self-defeating outcomes for all involved. f

Cliché that it is, the blame game is an art form. An art form that has trapped the current PM, who said before the 2007 general election ……………..

“The buck stops with me. I will stop the blame game. And if the States do not fix hospital healthcare by June 2009, I will step in and fix it ………….”
Hmmm! This is September 2009 and …………….?
Obviously, the buck hasn’t stopped yet.

The PM is the highest level public servant in the land and here we have again the usual false dawn.
Say it, shuffle it, spin it, but do it?
Not happening mate.
Not happening at all.
What would his Grandma say?

Whatever, it is hardly the fault of any one person, as hard facts and harsh words have little leadership meaning or impact anywhere across the landscape.

These public representatives are paid from the public purse and we have given them responsibility over huge buckets of funding.
This however, isn’t their money- it’s ours.
So, just hold that thought for a moment.

How many more smoothly written consultant reports, contrasting with screaming newspaper headlines and TV exposes can we stomach only to be subjected over and over again to ministerial and unattributed bureaucratic platitudes.

Platitudes (Macquarie Dictionary): “a flat, dull, trite remark; offered as important as if fresh and profound”

Sure it is easy to criticize and sure it is easy to take the mickey, but surely at some time soon someone will actually try and turn the charade around to something we can be proud of.
This is not of course talking about the front line clinicians and health workers; this is all about the invisible cadre of boat anchors variously described as advisers, policy makers, policy implementers, ‘managers’ and above all the perennial - ‘Yes Minister’ public servant class.

I like to avoid calling any one a servant.
Or engaging in ‘class’ descriptors –it is so last century, but maybe we should bite that bullet.
Servants – that is what they are and that is how we should deal with them.

Serve us or get out of the damn way!

Let me really take the micky for a moment.
We have had war stories again and again from hospital suppliers who show proof of not being paid anywhere near close to time (+90 days instead of 30 days).
It goes on and on.
I heard a company owner on the radio saying things go bad gradually over a three or four month period.
He doesn’t get paid and the debt climbs to $100,000s overdue.
He makes a noise on radio and whammo, he gets the cheque.
A few months go by and then the nonsense starts all over again.

Put the boot on the other foot.
If we do not pay the State on time they take punitive action and add interest to the debt.
Yet, as many have pointed out, the real problem here is that not paying the bills on time eventually ripples through and impacts on patients.

The supplier can not add interest to the debt so they stop supplying; ergo a nurse reaches for a medication or a surgical item and there are none on the shelf.
And, for the hundredth time, it is not a lack of funding.
There is plenty of money in the kitty.
It is merely a matter of incompetence in being able to cope with the paperwork.
The short story is that bad inputs will deliver bad outputs - a fact that eludes the non-clinical hierarchy who seem incapable of matching the quality of work given by the care-givers with an equal supporting performance.

Sack ‘em all and start again is an answer; but this will never happen overnight.
It can only happen if a start is made to tell the truth.
If the poor performance is acknowledged openly then human nature will take over and ways will be found to make things better.
I am not holding my breath.

By way of example and back to the late payments scandal.
Two weeks ago we heard on a Sydney radio program the NSW Health Minister, whomever was in the job this month, answering the complaint above by saying in mushroom platitudes:

‘I am advised that the problem is very small and is really only about 2% of our procurement budget”.

Oh yeah. Who fed him that porky?

Porky: Macquarie dictionary): “a fib; meaning fat chance of accuracy”

All too often this is all we get – the dreaded porky dressed up as a ‘sound bite’.
Stuff and nonsense cleverly presented to, as ‘ol Jo used to say in Queensland, "feed the media chooks".
When you think on it we have been drowning in sound bites from the spokespeople whenever they want to, or are forced, to comment on the (lack of) e-health progress.
Could that be why our grandparent’s generation built so much infrastructure in the first half of the 1900s?
There was no mass media to manipulate.
If you wanted to be noticed in public life you had to make decisions and actually do or build something -  or fade into voter oblivion.

Today it seems ‘decisions’ are more about what to order for lunch than nation building.
Unless, of course, it relates to installation of pink batts or similar golly-gosh antics.

Then we had the courageous doctor and his colleagues at Hornsby hospital who expressed their despair and anger by inviting the cameras into the wards to show us all the truth.
If you saw it, the performance by the General Manager, cringe worthy as it was, his reaction said it all. All he wanted was the cameras to be turned off acting as if this hospital belonged to him.

But wait.
What happened the very next week is a classic horror story.
The Hornsby hospital lost $9 million in funding apparently as punishment.
Talk about shoot the messenger.
Laugh? Cry?
Suit yourself.

Then in the realm of activity, that I am supposed to write on in this publication, we can always refer to papers on - ‘National E-health Strategies”.
There are four that have been published over the past eighteen months or so.
All about the one hundred to two hundred odd page efforts.
All full of word-smithing and top down observations.
This is not to say that the content is wonky or misguided.
Not at all.

The irritating and enormously frustrating bit is that only one of them has ever been made public.
Now, I know this is not the sole fault of the health community, a lot of government reports never see the light of day, but, hells bells, how are they going to make huge public lifestyle change work if it is kept a secret?
So counter intuitive that it defies logic.
Unless of course they do not truthfully know what or how to do ‘it’. Which is merely yet another way of fibbing.

So one wants to shout and dance about saying thinks like:

Hey Jack what is the secret about e-health, personal IDs, EHR and where does all the money go to?
We are the public.
We are the taxpayers.
We are the health consumers.
We are the electors.
We are the servant’s bosses.
We want to know.

Sigh!

Where does that get you?
Back into the field of mushrooms fed on rocking horse manure.

We all fib.

Fib (Macquarie dictionary): “a trivial lie; falsehood replicating a fable.

And there are thousands of different types off fibs.
Pretending to do a job and not delivering on it is a form of fibbing.

As is kidding oneself that important work is being done when in reality the only output is all smoke and mirrors.
As normal citizens our personal fibs do not involve the custodianship of healthcare administration, healthcare infrastructure and healthcare information technology implementation; all of it publicly funded.
All of it practiced under blankets of secrecy, platitudes, lots of fibs, and all wrapped up in too much hidden incompetence.

Before I really tell you what I think, I forget to tell you about Grandma.

My Grandma (true) said something to me when I was a little ankle biter that (true) I have never forgotten:

”Snowy” she said, “I want you to never forget this rule” ………………………………………………….
”never tell a lie, because sooner or later you will forget that you told a lie and what the lie was”………………………..and …………………….

Please fill in the gaps yourself.

How true and how sad that so very few people ever seem to have had the good fortune to have a Grandma like mine

Last week an article was published, in a national newspaper, under a heading:
‘Health professionals diagnose unfair comparisons’

So help me, it was excruciating to read.
The journalist did a proper job reporting what was said.
However what wasn’t said, or picked up on, were the ludicrous excuses hiding the fibs.

In a nut shell the message was that we can not compare public hospital performance to private hospital performance because it is meaningless and unfair.

You can take it that, what was really meant, was to say it is a mean thing to try and do.
Furthermore the underlining reason, why this would be mean and nasty, was a lack of data in the public sector.

Oh really, fancy that! – who would of dreamed that they have no data on which to manage and deliver services?

Read this quote and ask yourself what you would do if this was your responsibility:

“Comparisons between two systems would only contribute to improved transparency, accountability and performance if the fundamental differences between the two systems were taken into account”

Beautiful and pure male bovine manure.
In a few words this says that the MBA training book on management says we should use these pretend words like transparency, accountability and performance, but it can not be applied to us.

You can compare the other mob but do not try and do that to us.

After all, that would be mean.
Here, would you like my hanky?

Frankly, I would proffer another reason that is closer to the truth, generally speaking.

The private hospital bean counters have a reasonable idea what the numbers are; they are driven and reported on by P&L accounts and auditing.

The public wallahs simply do not have any information to speak of in comparison to the private guys that is timely, useful or accurate data.
So if meaningless equates to ‘we don’t know’, then of course the comparison will only tell us the news in three dimensions:
a) the overall picture is very bad;
b) we don’t have the ‘isms’ to fix it; and
c) so how dare you ask us to show the true picture

Just another variation of endemic fibbing

If these people and I am sure there are many fundamentally good people, choose to face the facts and gradually fix the malaise then we will all be better off – including them.
Starting with basic ICT systems that capture, reticulate, share and store reliable data on costs and expenditure, waste and consumption, payments and income, performance and efficiency gaps.

It isn’t hard to do, but it is still very much culturally uncomfortable to do so.

While ever they get away with living the fib, we will keep getting told the fibs.
I kid you not!

Back to the mention of ‘hold the thought’ above. Let’s get some accountability happening here.
Comparison is exactly what is needed.
First identify the problem and then fix the problem, as best that can be done, should be the mantra of every respectable manager.
It shouldn’t be seen as an imposition for heaven’s sake

Watch the watchers: why really did grocery watch and fuel watch fail?
Vested interests didn’t think it was a good idea at all.
So, although it is with little chance of success, for the same reasons – let’s have hospital watch.

Although not just for adversarial purposes as a judge and jury show.
As this information can also serve a very useful awareness and change enforcement purpose.

Let the Hospital-watch web site be open to all managers and supervisors in all our hospitals.
This will do several things:
a) encourage line managers to update their data;
b) that others can exponentially benefit from the combined picture;
c) so that the incoming information seeker can be assured that she/he will be able to compare apples to apples when they ask a question for a regional hospital with 100 beds; and finally
d) although anonymous in this context it will introduce the healthy aspect of a sense of competition that is natural in most of us, to do well.

I know there are the usual suspects out there who abhor competition, while hypocritically enjoying the beneficial outcomes of healthy competition.
Forget-about-them, they can play in the dark by themselves.

Many years ago a certain pharmacy chain operator, that I am familiar with, offered a similar service that was taken up enthusiastically by the community members.
Why?

Knowing how you selectively, in a like-to–like manner, measured up against a similar pharmacy, say, in an area with lots of babies, or with an aged population, or as a beachside location was tremendously valuable knowledge.
Why not give a hospital pharmacist, a NUM in a maternity ward, a supply manager in a children’s hospital or an accountant in a large city hospital, the same helpful knowledge?

Why indeed?

The mandatory reporting program and information disseminating web site could be run by the Productivity Commission (PC) and the criteria could be as simple as ten or twenty basic management (not clinical) related questions.
The program could run for three years before re-funding if all is well.

The PC could monitor: average bed cost, cost to bed ratio, procurement to bed ratio, overall patient/staff ratio, scripts to bed ratio, management numbers to patient ratio, wait list performance, account payable performance, inventory to beds ratio, umm, yawn ……. to beds ……..

aahhhhh….. is that the alarm clock ringing ………I must have been dreaming again.

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